A single strategically placed unilateral lesion can cause bilateral dysfunction. In addition, a bilateral cerebellar syndrome can occur with unilateral lesions in the lower midbrain with a wide range of other clinical features.
Tremors in association with thalamic haemorrhage have been infrequently reported, and delayed rubral tremor as a complication of such an event is quite rare. We describe a patient with a combined resting-postural-kinetic tremor due a thalamic haemorrhage. Magnetic resonance imaging showed evidence of a subthalamic involvement but failed to reveal any mesencephalic lesion. Five years after the original stroke there was rapid and almost complete suppression of her abnormal movements, probably related to an ischaemic capsular lesion. Involuntary movements, which resemble rubral tremor, can be due to lesions upstream of the rubral and nigral outflow system.
Hemi-infarction of the medulla causes the clinical constellation of symptoms and signs of both the lateral and medial medullary syndromes and nearly always results from occlusion of an intracranial vertebral artery. In the case reported here, with a clinical diagnosis of hemimedullary syndrome, the expected infarction was imaged by magnetic resonance. A review of the literature confirms that the hemimedullary syndrome, in which both medial and lateral syndromes occur simultaneously, is extremely rare, since it yielded only two previous cases with adequate anatomical confirmation.
We report a further case of retarded contralateral hemiplegia syndrome after herpes zoster ophthalmicus in which the motor deficit was caused by an ischemic infarction in the territory supplied by the anterior choroidal artery. We discuss the clinical and physiopathogenetic features of the case and consider the computed tomographic and neurological patterns of anterior choroidal infarction.
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